Mucormycosis

Mucormycosis

Mucormycosis is a serious fungal infection that develops on exposure to a group of molds called mucormycetes. This life-threatening infection generally affects immunocompromised individuals and patients on immunosuppressant medications. It is non – contagious and cannot spread between people or between people and animals.

Types:

  • Sinus and brain (rhinocerebral) mucormycosis – The fungal infection spreads to the brain from the sinus. It is commonly seen in patients with uncontrolled diabetes. Read Diabetes- Detection Prevention and Management
  • Lung (pulmonary) mucormycosis – Patients with cancer or those who have undergone organ transplantation are more likely to get this infection. read Organ Transplant: A Boon in Irreversible Organ Failure
  •  Gastrointestinal mucormycosis – It affects young children and low birth weight infants who are on antibiotics or immunosuppressant medications. 
  •  Skin (cutaneous) mucormycosis – Exposure to fungi via a break in the skin due to skin trauma or surgery causes this infection in people with normal immune systems.
  • Disseminated mucormycosis – In this type, the infection spreads to other parts of the body like the brain, spleen, heart, etc., through the bloodstream.

Causes:

  •  Mucormycosis is caused by fungi spores called mucormycete spores found in soil and decaying organic matter like leaves and animal dung.
  • These fungi are widespread throughout the environment, and most people come in contact with it every day. 
  • But infection manifests only in people with a weakened immune system. Healthy people generally do not get infected even if they come in contact with these spores.
  • In immunocompromised individuals, it causes infection in the lungs or sinuses. Over time, this infection spreads to other parts of the body like the spleen, heart, and skin via systemic circulation.
  • Cutaneous mucormycosis occurs when the fungal spores enter the skin via a scrape, burn, or skin injury. Community–onset outbreaks of mucormycosis occur mainly due to traumas sustained during national disasters.
  • The fungal species belonging to the order Mucorales cause this infection. The fungi include Rhizopus species, Mucor species, Rhizomucor species, Syncephalastrum species, and Saksenaea.

Risk factors:

  • Despite being a rare fungal infection, mucormycosis is frequently seen in people with poor health and those taking medications that suppress their immune systems. 
  • Some people are at a higher risk as compared to others, and the conditions which predispose these people to mucormycosis are :
    • Uncontrolled diabetes mellitus, especially diabetic ketoacidosis.
    • Neutropenia.
    • Prolonged–term use of corticosteroids.
    • Iron overload in the body or hemochromatosis.
    • Organ or stem cell transplantation.
    • Bone marrow transplantation.
    • Skin injury due to burns, wounds, or surgery.
    • Prematurity and low birthweight (for gastrointestinal mucormycosis in neonates).
    • Immunologic deficiency either due to a primary disease or to the treatment of other conditions.

Mucormycosis Signs and symptoms

  • The prominent symptoms of the different types of mucormycosis are as follows :
    • Symptoms of rhinocerebral mucormycosis –
      • Swelling of the face on one side
      • Headache
      • Nasal or sinus congestion
      • Fever
      • Black lesions on the nasal bridge or upper inside of the mouth
    • Symptoms of pulmonary mucormycosis – 
      • Fever
      • Cough
      • Chest pain
      • Shortness of breath
    • Symptoms of cutaneous mucormycosis –
      • Black blisters in the infected area
      • Pain, warmth, and redness around the wound
      • Swelling of the wound area
    • Symptoms of gastrointestinal mucormycosis –
      • Abdominal pain
      • Gastrointestinal bleeding
      • Nausea and vomiting
    • Symptoms of disseminated mucormycosis –
      • Mental status changes or coma occurs if the infection affects the brain

Diagnosis of Mucormycosis

  •  Mucormycosis must be diagnosed as soon as possible to decrease mortality.
  • The doctor thoroughly evaluates the patient’s medical history and symptoms, and a physical examination follows this. 
  • Biopsy – The healthcare provider generally recommends confirming the presence of mucormycosis with the help of a biopsy. A sample of the affected tissue is taken and sent to the pathologist for evidence of mucormycosis. The samples collected for the laboratory analysis depend on the type of infection suspected. It usually includes fluid from the respiratory system, sputum (mucus coughed up from the lungs), or skin tissue.
  • Fungal culture – Biopsy is often done along with fungal cultures to determine the presence and type of fungal infection. The sample of the affected tissue is sent to a laboratory, wherein the fungi discovered in this tissue are allowed to grow.
  •  Some physicians do imaging techniques – Computerized tomography (CT) scanning to locate and identify the extent of infection in the lungs, sinus, and other body structures. The CT scan of patients with mucormycosis often reveals an area of necrosis that resembles ground glass on the film. Check CT Scan cost in India

Mucormycosis Treatment

  • Treatment aims at inhibiting the growth of the fungal infection and preventing its spread to other parts. 
  • Medications – Antifungal medicines such as amphotericin B, posaconazole, or isavuconazole are administered over several weeks to improve the patient’s condition. 
  • Surgery – Surgical debridement is often done to remove the infected or dead tissue, damaged skin, and involved subcutaneous tissue.

Prevention:

  • Avoid areas with a lot of dust like construction sites, or wear an N95 respirator while going to such places.
  • It will help if you avoid direct contact with water-damaged buildings and flood water.
  • Gloves must be worn while handling soil, moss, or manure.
  • Clean skin injuries with water, especially if they have been exposed to soil or dust.
  • Consult with the doctor if the infection does not improve or aggravates despite taking antifungal medications.

Health Professionals :

If the symptoms aggravate or do not respond to the treatment prescribed by the infectious disease expert, then it is best to consult with the specialist recommended to the patient. Specialists vary for each type of infection as follows:

  • Rhinocerebral mucormycosis – Otolaryngology (ENT) and neurosurgery consultation.
  • Pulmonary mucormycosis – Thoracic surgery consultation.
  • Cutaneous mucormycosis – Dermatology consultation

References: